“Everyday, there is a theme to our rounds, and I will ask for your thoughts at the end.”
This was the warning our attending physician gave before we went to see our patients on the hospital inpatient floor. As third-year medical students on our first clinical rotation in pediatrics, we were eager to face any challenges that would come our way. After months of isolation studying for our first board exams, and watching the war with COVID rage from the sidelines, we were desperate to contribute any shred of naïve knowledge to help. We expected routine cases of respiratory difficulties, abdominal pains, and diffuse headaches, with occasional zebra cases sprinkled into the array of patients we would see in our large metropolitan medical center. However, our patient experience was much narrower.
The first patient to present was a neonate I had been following. She was a classic case of failure to thrive, a two-month-old the size of a newborn. I had generated a list of congenital syndromes and metabolic diseases that could explain her fragile state, yet the answer lay in the absent visitor chair in the corner. Forty-eight hours and I had not met a single family member. I tried to fill the empty space myself as often as I could. I struggled not to be angry at this mother’s continued absence until I learned of her difficult life attempting to care for four other very young children while also working. I hoped this would be an anomaly, but as morning rounds continued, the patients mirrored my own. One after another, young infants were not receiving the nutrition they needed, and parents struggled to meet the demands of their growing bodies. Even the teenagers were lining up with protein-calorie malnutrition and anorexia nervosa. Our generally light-hearted, bubbly attending seemed to drag her feet more and more after every additional patient added their weight. We could calculate calories and correct electrolyte imbalances, but we could not correct the root problem that had spread its reach to our most innocent population.
Two hours later, the theme of the day was clear. Failure to thrive and malnutrition due to psychosocial factors had affected nearly all of our patients — there was no internal pathology to be found. Rather their psyches were reacting to the stressors ensuing from a global pandemic, and their bodies were suffering the consequences of an economic freefall. This year we have seen COVID-19 spread through the world, amplifying each daily stressor. The economic collapse coupled with societal shut-downs handicapped parents as they attempted to feed and clothe their children. Cosmic stressors — the loss of jobs, the effects of isolation, the loss of beloved friends and/or family to illness — trickled down to the smallest members of our society. And so, I and other members of my cohort saw hospital rooms filled with pediatric patients who bore the psychosocial brunt of this pandemic. During that first week in the hospital, I learned that disease spreads not just through fomites, but through the ripples it creates in society.
As the pandemic continues to reverberate through our economy and society, we would do well to consider how we can prevent infants and children from returning to our hospital beds with failure to thrive and protein-calorie malnutrition. How can we ensure healthy food is consistently provided to children? How can we ensure parents are receiving the support they need? There are no easy answers to these questions. We know this because we have seen the efforts made and seen their insufficiency. Here is a call from those patients on the pediatric ward to be creative: What if closed schools still provided lunches for pickup or delivery. Maybe social media, which we rely on so heavily for social comfort these days, can be turned into a tool for students and parents to share their struggles. Although policy and advocacy will be an important solution, immediate progress will come from those interacting with children and their parents every day. Physicians have always been in a unique position to offer hope in times of need. Now more than ever, our compassion, empathy, and creativity are called on.
Amy Cox and Rachel Kalthoff are medical students.
Image credit: Shutterstock.com
